Ultraselective intra-arterial perfusion of papaverine and transluminal baioon angioplasty in early stage in symptomatic cerebral vasospasm after aneurysm clipping

作者：Jun Chen, Tan Chen, SI Xian-ping, Haibin Wu, Yan Shi-wei, Aimin Li, Hui Shi, Fuyuan Wang, Wei Jiang, Xiguang Liu, Wei-ye Sun, Hui Zhou, Ning Li, Kai Ma · 发表于：中国综合临床 · 年份：2009 · DOI：10.3760/cma.j.issn.1008-6315.2009.01.036 · 研究领域：Intracranial Aneurysms: Treatment and Complications、Vascular Malformations Diagnosis and Treatment、Cerebrovascular and Carotid Artery Diseases

Objective To study the efficacy of uhraselective intra-arterial infusion of papaverine and transluminal baloon angioplasty(TBA)in early stage in symptomatic cerebral vasospasm after aneurysm clipping.Methods 76 patients whose intracranial aneurysms were clipped,were treated within 8 hours after their clinical symptoms had deteriorated remarkably,and 0.3%(w/v)papaverine perfusion was performed.TBA was used to eliminate the stenosis in extracranial arterial in 12 cases.The changes of mean blood flow velocities(mBFVs)on the severe side of the middle cerebral artery were measured by transcranial Doppler sonography(TCD),and the clinical efficacy was evaluated by Barthel index before and after treatment.Results TCD showed that mBFVs in the middle cerebral artery decreased from(149±4)cm/s to(108±5)cm/s(t=38.31,P＜0.05).The consciousness,limb movement and language function improved significantly in 76 patients after the procedure,and their Barthel index had increased significantly(29±6 vs 49±7,t=32.12,P＜0.05).Three months after treatment all patients were recovered,including better in 61 cases(80.26%),poorer in 12 cases(15.79%)and death in 3 cases(3.95%).Conclusion Ultraselective intra-arterial infusion of papavenne and transluminal baloon angioplasty in early stage for symptomatic cerebral vasospasm after aneurysm clipping is an effective method. Key words: Subarachnoid hemorrhage; Vasospasm; Transluminal baloon angioplasty; Papaverine